Acceptance and commitment therapy (ACT)

Language is a double-edged sword4

The same mind that plans and solves problems also relives the past, scares itself about the future and judges itself.

Experiential avoidance6

Trying to get rid of unwanted thoughts, feelings, memories and sensations, even when it harms you in the long run. Short-term relief keeps it going.

Fusion2

Being so caught up in thoughts that they act like literal truths or rules that must be obeyed.

FEAR versus ACT1

Problems come from Fusion, Evaluation, Avoidance and Reason-giving; the alternative is Accept, Choose, Take action.

Not symptom reduction4

Labelling a feeling a "symptom" starts a fight with it. ACT aims at a full life; less distress tends to follow.

Functional contextualism5

Behaviour is studied as an act in its context, and an idea counts as true when it works. Hayes built ACT and Relational frame theory on it.

Acceptance3

Making room for unpleasant feelings and urges, letting them come and go without a struggle. It serves values, not an end in itself.

Cognitive defusion3

Stepping back from thoughts to see them as words and pictures, changing how they work rather than what they say.

Contact with the present moment3

Ongoing, non-judgemental attention to what is happening now, inside and around you.

Self-as-context4

The observing self: a part of you that notices thoughts and feelings without being them.

Values3

Chosen qualities of action, such as being caring, that can be lived each moment but never ticked off like a goal.

Committed action3

Setting goals guided by values and building larger and larger patterns of action around them.

Experiential avoidance4

A depressed client cancels a social engagement to avoid thoughts like "I'm a burden" and "I have nothing to say". The relief is short-lived, and the growing isolation deepens the depression.

Defusion4

A socially anxious client pictured his thought "I'm a loser" as words on a karaoke screen, changed the font and colour, and added a bouncing ball. Minutes after it had brought him to tears, he was chuckling at it.

Acceptance4

Imagining an office party, the same client felt a "huge knot" in his stomach. He studied its edges, shape, weight and temperature like a curious scientist and made room for it, and felt at ease with the anxiety though he still did not like it.

Contact with the present moment4

He ate one sultana in slow motion, attending only to taste and texture while letting thoughts come and go. His homework was to bring the same attention to showering, brushing his teeth and to the person he was talking with.

Self-as-context4

With eyes closed he watched his thoughts while the therapist said: "There are your thoughts, and there is you noticing them." From the noticing side, no thought is dangerous or controlling.

Values4

He named connecting with others, close friendships and being genuine. Asked "If taking your life in the direction of these values means you need to make room for feelings of anxiety, are you willing to do that?", he said yes.

Committed action4

His first goal was lunch with a work colleague every day, sharing something personal each time; later goals got harder. Thoughts of being "a loser" still came, but he mostly stopped taking them seriously.

Values vs goals11

Getting married is a goal: you can achieve it and tick it off. Being loving is a value you can live right now, towards friends, a pet or even your houseplants, whether or not you ever marry.

Creative hopelessness4

The client lists everything tried to get rid of the pain, and asks of each: did it work long-term, and what did it cost?

Control is the problem4

Metaphors such as quicksand show that struggling with feelings pulls you further in.

The struggle switch4

With the switch on, you get anxiety about your anxiety. The extra layer is "dirty discomfort"; the unavoidable part is "clean discomfort".

Defusion in practice4

Say "I'm having the thought that I'm a loser", sing it to "Happy Birthday", or say "Thanks, mind". None of it disputes the thought, unlike classic CBT.

Willingness and values4

The client names what matters, then is asked: to move that way, are you willing to make room for the anxiety?

Worksheets8

Russ Harris's free tools include the Choice Point, values checklists and "dropping anchor" recordings.

A large evidence base1

A 2020 review of 20 meta-analyses (133 studies, 12,477 people) found ACT efficacious for every condition examined.

About as good as CBT1

A 2015 review found ACT better than placebo and usual treatment, and similar to CBT.

Recognised by guidelines1

APA Division 12, the WHO and the UK's NICE have listed ACT as empirically supported; the WHO's Self-Help Plus course is based on it.

Early doubts1

A 2008 meta-analysis by Öst judged the evidence then too limited; a 2026 AHRQ review found limited evidence in teenagers.

Is it new, and why does it work?1

Critics say its novelty is overstated and that it cannot yet show its unique parts are the active ingredients (Herbert and Forman, 2013).

Over-promotion1

Jonathan Kanter criticised "excessive promotion" of ACT, and O'Donohue and colleagues (2016) said some trials were made easier to pass.

The Happiness Trap (Russ Harris, 2007)9

The best-selling self-help introduction: dropping anchor, the struggle switch, living by values.

Embracing Your Demons (Russ Harris, 2006)4

A short, free overview article with a full case example of all six processes.

Acceptance and Commitment Therapy (Hayes, Strosahl and Wilson, 1999; 2nd ed. 2012)1

The founding clinical text.

Get Out of Your Mind and Into Your Life (Hayes and Smith, 2005)1

Hayes's self-help workbook.

The Oxford Handbook of Acceptance and Commitment Therapy (2023)1

An edited academic handbook (Twohig, Levin and Petersen).

What Steven C. Hayes says about ACT (opens korrents.com)10

"ACT is not a technique, it's the application of a model called psychological flexibility."